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<p>[QUOTE=&quot;charley, post: 8273679, member: 5372&quot;]I appreciate the reply. A&amp;E has undergone 7 on-site CMS Audits since 2010,and 12 CMMS QRP Reporting Requirements for APU thru 2019. If you were the Medical Director, you are aware of EHR/EMR Systems Requirements and Coding/Reporting via the Intermediary (McKesson Et Al) to CMMS and the Triggers built into the EHR Programs- the one designed by Athena comes to mind-that, if it doesn&#039;t smell right, the LCD makes a sniff check. It is how 70% of these clowns are caught. 88% of Medicare Fraud cases are adjudicated with a conviction. I also rest assured you are very aware of the excellent anonymous reporting program for Medicare Fraud...I hope so, since it is required to be posted in every healthcare facility and every employee to be made aware of the program (There is a hefty Fine for not doing so). The question is, why did you not avail yourself of this outstanding program?</p><p><br /></p><p>I know of no such silliness as a Task Force not responding to a complaint unless it is over 1 Million Dollars. In 2019, $5.9 Billion in both Civil and Criminal Medicare Fraud&nbsp; was recovered, with an average Task Force AOO recovery per incident rate of $213,000.00. I know of no Tsk Force that does not include FBI/DOJ/OIG/Local AG&nbsp; representation. By Statute, CMMS Fraud complaints are prioritized by DOJ using a 60 CD response mechanism.</p><p><br /></p><p>As a Medical Director, you are certainly aware of the generous Reward program CMMS has for Anonymous Fraud Tips.</p><p><br /></p><p>We all have a dog in the fight. It is our tax dollars. That is a worthwhile fight for all of us.</p><p><br /></p><p>Whether or not someone was trying to impress you for some ulterior motive (including recruiting you to be a potential part of a Fraud scheme) I don&#039;t know.&nbsp; I agree, there are valid irregularities that deserve scrutiny of the FBI and vigilance. However, CMMS Medicare Fraud Task Force response is not one of them. It is one of the most successful taxpayer money recovery programs we have, year after year.[/QUOTE]</p><p><br /></p>

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